Document Detail

Quality indicators for sentinel lymph node biopsy: is there room for improvement?
MedLine Citation:
PMID:  23351501     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Eleven quality indicators (QI) for sentinel lymph node biopsy (SLNB) were previously developed through a consensus-based approach, yet still need to be incorporated into clinical practice. We sought to evaluate the applicability and clinical relevance for surgeons.
METHODS: Breast cancer patients undergoing SLNB between 2004 and 2008 at Mount Sinai Hospital, Toronto, were evaluated. Clinical and pathological data were obtained from an institutional database. Information on axillary recurrences was obtained through a retrospective chart review. Adherence to standardized protocols was evaluated in each case.
RESULTS: All 11 QIs were measurable in 300 patients. The identification rate was 100%. More than 1 SLN was identified in 78.6% of patients. The SLNB was performed simultaneously with primary surgery in 96.7% of patients; 61 SLNs harboured metastasis. Of these patients, 80.3% underwent completion lymphadenectomy. Cases complied with protocols for radiocolloid injection and pathologic SLN evaluation/reporting. No ineligible patients underwent SLNB. Of patients with a complete 5-year follow-up (n = 42), only 1 had axillary recurrence.
CONCLUSION: Applying QIs for SLNB was feasible, but modifications were necessary to develop a more practical approach to quality assessment. Of the 11 suggested QIs, those that encompass protocols (nuclear medicine and pathology) should be reclassified as prerequisites, as they are independent of the technical aspect of SLNB performance. The remaining 8 QIs encompass surgery per se and should be measured routinely by surgeons. Furthermore, concise and clinically relevant target rates are necessary for these QIs to be established as widely recognized control standards.
Sergio A Acuna; Fernando A Angarita; David R McCready; Jaime Escallon
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Canadian journal of surgery. Journal canadien de chirurgie     Volume:  56     ISSN:  1488-2310     ISO Abbreviation:  Can J Surg     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-03-22     Completed Date:  2013-05-16     Revised Date:  2013-07-11    
Medline Journal Info:
Nlm Unique ID:  0372715     Medline TA:  Can J Surg     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  82-8     Citation Subset:  IM    
The Department of Surgery, University of Toronto, Toronto General Research Institute, Toronto, Ont.
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MeSH Terms
Aged, 80 and over
Breast Neoplasms / pathology*
Carcinoma, Intraductal, Noninfiltrating / pathology
Delphi Technique
Lymph Node Excision
Lymphatic Metastasis
Middle Aged
Quality Indicators, Health Care* / standards
Sentinel Lymph Node Biopsy*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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